Large volume drainage of malignant pleural effusions: risks and benefits

Abstract

PURPOSE: To prevent Re-expansion Pulmonary Edema (RPE) when draining malignant pleural effusions (MPEs), the maximum drainage on a single occasion has often been arbitrarily limited to 1L. Few studies have addressed the potential risks and benefits of draining larger volumes. METHODS: Seventy-four consecutive patients with large, symptomatic MPEs received chest tube insertion by a Cardiothoracic Surgery unit. At the surgeon’s discretion, maximum daily drainage in 32 patients (43%) was limited to 1L. Drainage volumes, clinical progress and serial chest X-rays were assessed for all patients. RESULTS: In the first hour, the mean volume drained in this cohort overall was 773ml, and over 1L was drained in 30 patients (41%). No patient developed clinical or radiographical RPE as defined by established diagnostic criteria. Five patients (6.8%) developed self-limiting coughing for less than 20 minutes, but no association with initial drainage of over 1L was observed (p=0.32). No other drainage-related complications were experienced by any patient. In patients for whom no maximum daily drainage limit was set, within 24 hours symptomatic improvement was noted in 93% and complete resolution of the MPE on chest X-ray was observed in 40%. This compares to 84% and 28% respectively in those who had limits set, although the differences fell short of statistical significance. In 65 patients for whom chemical pleurodesis was planned at the time of chest tube insertion, the mean interval between tube insertion and pleurodesis was significantly shorter in patients for whom no maximum daily drainage limit was set (4.1 days versus 5.8 days, p=0.04). CONCLUSION: For large, symptomatic MPEs, drainage of 1L or more in a single sitting appears to be safe.